<section class="panel panel-default" xmlns="http://www.w3.org/1999/html" xmlns="http://www.w3.org/1999/html">
</br>
        <div class="container-fluid">
            <div class="row">
                <div class="col-lg-9">

                    <div class="row">
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >卡  号:</label>
                                    <input type="text" class="form-control" placeholder="请输入卡号">
                                </div>
                            </form>
                        </div>
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >物理卡号:</label>
                                    <input type="text" class="form-control " placeholder="请输入物理卡号">
                                </div>
                            </form>
                        </div>
                    </div>


                    <p>
                    <div class="row">
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >姓  名:</label>
                                    <input type="text" class="form-control" placeholder="请输入姓名">
                                </div>
                            </form>
                        </div>
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label>性  别:</label>
                                    <label class="radio-inline">
                                        <input type="radio"  name="inlineRadioOptions" id="inlineRadio1" value="option1"> 男
                                    </label>
                                    <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> 女
                                    </label>
                                </div>
                            </form>
                        </div>
                    </div>
                          </p>

                    <p>
                    <div class="row">
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >微信昵称:</label>
                                    <input type="text" class="form-control" placeholder="请输入微信昵称">
                                </div>
                            </form>
                        </div>
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >微信ID:</label>
                                    <input type="text" class="form-control" placeholder="请输入微信ID">
                                </div>
                            </form>
                        </div>
                    </div>
                    </p>
                    <p>
                    <div class="row">
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >提示信息:</label>
                                    <input type="text" class="form-control" placeholder="请输入提示信息">
                                </div>
                            </form>
                        </div>
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >附卡费:</label>
                                    <input type="text" class="form-control" placeholder="请输入附卡费">
                                </div>
                            </form>
                        </div>
                    </div>
                    </p>

                    <p>
                    <div class="row">
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >手机号码:</label>
                                    <input type="text" class="form-control" placeholder="请输入手机号码">
                                </div>
                            </form>
                        </div>
                        <div class="col-lg-6 ">
                            <form class="form-inline">
                                <div class="form-group pull-right">
                                    <label >与主卡关系:</label>
                                    <input type="text" class="form-control" placeholder="请输入与主卡关系">
                                </div>
                            </form>
                        </div>
                    </div>
                    </p>


                </div>
                <div class="col-lg-3">
                    <img src="images/club/photo.jpg"
                         class="img-rounded"><br>
                    <button type="button" class="btn btn-success">上传照片</button>
                </div>
                    </div>
                <p>
                <div class="row">
                    <div class="col-lg-3 ">
                        <form class="form-inline pull-left">
                            <div class="form-group ">
                                <label >登记日期:</label>
                                <label >2015-04-02</label>
                            </div>
                        </form>
                    </div>
                    <div class="col-lg-3">
                        <form class="form-inline">
                            <div class="form-group">
                                <label >操作人:</label>
                                <label >李泽</label>
                            </div>
                        </form>
                    </div>
                <div class="col-lg-3">
                    <form class="form-inline">
                        <div class="form-group">
                            <label >卡押金:</label>
                            <label >200</label>
                        </div>
                    </form>
                </div>
                <div class="col-lg-3">
                    <form class="form-inline">
                        <div class="form-group">
                            <label >工本费:</label>
                            <label >200</label>
                        </div>
                    </form>
                </div>

                </div>
                </p>

            <p>
            <div class="row">
                <div class="col-lg-3 text-right col-md-push-3 ">
                    <button type="submit" class="btn btn-success">确定</button>
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    <button type="reset" class="btn btn-warning">取消</button>
                </div>

            </div>
            </p>



        </div>
        </div>















    </section>


